Footnote: Calculated from date of last reported mensus. The county-level data reflect the mother's county of residence, not the county in which the birth occurred. LNE (Low Number Event) refers to data that have been suppressed because there were fewer than 20 preterm births. Data exclude infants for whom preterm birth information is missing. N/A means that data are not available.

In addition to being at higher risk of death during the first year of life, low birthweight babies are at increased risk of long-term disabilities, including developmental delays and learning disabilities, chronic respiratory problems, cerebral palsy, hearing and vision impairments, and autism (1, 2). Women who are more likely to give birth to low birthweight babies include those with low incomes, inadequate prenatal care, smoking habits, and those under age 16 or over age 45 (1).

Babies born prematurely also are at increased risk for similar adverse outcomes as low birthweight infants (3). Preterm birth is one of the leading causes of infant death in the U.S. (4). Most preterm babies require specialized care in a newborn intensive care unit (3). Women who are most likely to give birth preterm include those who have had a previous premature birth, those pregnant with twins, triplets, or more, and those with certain uterine abnormalities. In addition, demographic and behavioral factors can increase the risk of delivering preterm, including low socioeconomic status, being under age 17 or over age 35, inadequate prenatal care, and smoking during pregnancy (3). About 1 in 8 of all pregnancies in the U.S. result in preterm birth (1).

The percentage of California babies born at low birthweight increased from 6.1% in 1999 to 6.9% in 2005, and has remained fairly steady since then. At the local level, percentages range from 4.9% to 7.7% in 2012 among counties with available data. The state and all counties with data in 2012 met the national Healthy People 2020 objective of no more than 7.8% of infants with low birthweight. However, figures vary by demographic group. For example, California mothers age 45 and older consistently have the highest percentages of low birthweight babies (21.4% in 2012), compared to younger mothers. Among California's racial/ethnic groups with available data, African American/Black mothers consistently have the highest percentages of infants at low birthweight (12.0% in 2012).

California babies born at a very low birthweight has remained steady since 1995, hovering between 1.1% and 1.2%. The state and all but two counties with available data in 2012 met the Healthy People 2020 objective of no more than 1.4% of infants with very low birthweight.

In 2012, 9.6% of infants were born preterm, which represents a decline
from the high of 11.2% in 2005. At the county-level, figures range from 6.8% to 12.1% of infants born
preterm in 2012. Among counties with available data, all but three met the Healthy People 2020 objective of no more than 11.4% of infants born prematurely.

Policy Implications

Some of the risk factors for low birthweight and preterm birth can be influenced by public and institutional policy focused on education, prevention, and treatment. These factors include smoking, drinking alcohol, or using illicit substances during pregnancy; being a teenage mother; and being overweight or underweight (1).

According to research and subject experts, policy options that could influence low birthweight and preterm births include:

Providing access to early and regular high-quality prenatal care, including ensuring that pregnant women get adequate and appropriate nutrition (1), and avoiding increased risks of delivering early due to overweight and obesity (2)

Ensuring that health care systems train clinicians on identifying smokers among pregnant women, and that evidence-based tobacco cessation services are available to pregnant women and reimbursed by insurance (1)

Sustaining adequate funding for universal screening for substance use among pregnant women, and for treatment services specifically designed for pregnant women who use alcohol or illicit drugs (3)

Addressing depression and depressive symptoms in pregnant women as depression has been found to have an impact on the incidence of preterm labor and low birthweight (4)

Supporting a comprehensive approach to women’s health (1), including integration of reproductive planning into women’s routine health care by ensuring access to medical and dental services; included in this approach should be a focus on increasing interpregnancy intervals (at least 12 months), recognizing that short intervals are associated with increased risk for preterm birth (5)